APPLIED ANATOMY. 



upward to recognize the cervix entering the anterior vaginal wall. Firm pressure 

 with the other hand to depress the external parts is necessary to reach the posterior 

 fornix and Douglas's pouch. 



Cystocele. As a result of the relaxation following childbirth the bladder may 

 prolapse through the vaginal orifice. When the uterus prolapses it also drags the 

 bladder down with it. It is to be recognized by passing a sound through the urethra 

 into it. It is treated by excising the mucous membrane covering the cystocele and 

 sewing the sides of the wound together, thus crowding the mucous lining of the 

 bladder up into position (Fig. 466). 



Rectocele. The rectum prolapses at the posterior wall of the vagina the same 

 as the bladder does anteriorly and it is treated in a similar manner. 



THE FEMALE PERINEUM. 



The perineum in the female is much like that of the male. It has a central point 

 at which converge the external sphincter ani from behind, the superficial transverse 



Bulbocavernosus. 

 (sphincter vaginas) 



Tuber ischii 



Levator ani muscle 



Ischiocavernosus 

 muscle 



Triangular ligament 



Superficial trans, 

 perineal muscle 



Central point of 

 perineum 



FIG. 467. Female perineum. 



perinei muscles from each side and the bulbocavernosus muscles from the front. The 

 ischiocavernosus muscles lie along the rami of the pubes. These superficial muscles 

 are reinforced by the deep transverse perinei muscle, which comes from the ramus 

 of the ischium on the side to insert by its anterior fibres around the urethra (com- 

 pressor urethrae), its middle fibres into the vaginal wall, and its posterior fibres at 

 the central point of the perineum. Also the levator ani muscle inserts into the lower 

 end of the vagina anteriorly, then into the central point of the perineum, next into 

 the lower end of the rectum, and finally into the coccyx. The deep layer of the 

 superficial fascia ( Colics' s fascia) and the triangular ligament being pierced by the 

 vagina are not so marked as in the male between them lie the ischiocavernosus, 

 bulbocavernosus, and superficial transverse perinei muscles (Fig. 467). 



Rupture or Laceration of the Perineum. When the tear goes only part 

 way through the perineum it is called an incomplete laceration ; when it goes through 

 into the rectum it is a complete tear. 



In an incomplete tear the bulbocavernosus muscles (called also sphincter 

 vaginae) are separated behind and consequently their function of holding the labia 

 majora together is lost and the vulva gapes. In a complete tear all the muscles 



